title: Severity of infection following the introduction of new infection control measures for medical abortion.
abstract: BACKGROUND
  In response to concerns about serious infections following medical abortion, in early 2006 the Planned Parenthood Federation of America changed the route of misoprostol administration from vaginal to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, the Planned Parenthood Federation of America began requiring routine antibiotic coverage for all medical abortions. We previously reported a pronounced drop in the rate of serious infections following the adoption of these new infection control measures. Our objective in this study was to assess whether the degree of severity of the serious infections differed in the three infection control groups (vaginal misoprostol and no antibiotics; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, to assess whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories. Of particular importance is whether the new infection control measures selectively reduced the least severe serious infections but did not diminish the rate of the most severe infections.
  
  
  METHODS
  We performed a retrospective analysis assessing the degree of severity of infections before infection controls were implemented and after each of the two new measures was adopted: buccal administration of antibiotics with either screen-and-treat method or routine antibiotic coverage. We ranked the severity of infection from 1 (when treatment occurred in an emergency department) to 4 (when death occurred). We compared the distributions of the severity of serious infections in the three infection control groups (none; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, assessed whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories using the Jonckheere-Terpstra test for a doubly ordered 4 × 3 table.
  
  
  RESULTS
  The distribution of infection by severity was the same for all three infection control groups. Likewise, when the two new infection control groups--buccal misoprostol plus either screen-and-treat method or routine antibiotics--were combined, the distribution of infection by severity was the same before and after the new measures were implemented.
  
  
  CONCLUSIONS
  The pronounced decline in the rate of serious infections occurred in each category of severity.
authors.affiliation: Ipas, Chapel Hill, NC 27514, USA. fjerstadm@ipas.org
authors.forename: Mary
authors.initials: M
authors.lastname: Fjerstad
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.forename: E Steve
authors.initials: ES
authors.lastname: Lichtenberg
authors.forename: Irving
authors.initials: I
authors.lastname: Sivin
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cullins
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000009:adverse effects* / Q000379:methods*; D000278:Administration, Buccal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000517:prevention & control*; D004318:Doxycycline / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D000900:Anti-Bacterial Agents; D016595:Misoprostol; D015735:Mifepristone; D004318:Doxycycline